Pilot/Feasibility Project Grant

CRCHD

Application

Pilot/Feasibility Project Grant

Principal Investigator & Academic Title: Affiliation & Address Telephone, Fax & Email

( )

( ) ______

Project Title: UCSD/SDSU Faculty Program Leader:

This project involves: Have you received CRCHD funds in the last 24 months?

¨ Human Subjects o Yes

¨ Animal Subjects o No

¨ Recombinant DNA Research

Note: Items involving any of these three categories requires IRB approval before funding.

This project involves (check applicable boxes)

¨ Translation of laboratory finding from clinical application ¨ New Collaborations

¨ Phase 1 clinical investigation with laboratory correlations ¨ Prevention

¨ Improving access to health care for underserved populations ¨ Health education and/or information dissemination

¨ Preliminary efforts leading to a program-type application related to health disparities

Signature: Principal Investigator Date:

Signature: Department Chair Date:

Signature: UCSD/SDSU Program Leader Date:

Please prepare the application in the following format, with parts A-C not to exceed 5 pages: Use blank pages as needed:

A. Scientific Abstract (up to 100 words) F. Literature Cited

B. Specific Aims and Significance G. Biographical Sketches of Key Personnel (up to 2 pages each)

C. Research Design and Methods H. Other Support of Key Personnel

D. Human Subjects I. Amount Requested $ ______($50,000 direct costs)

E. Vertebrae Animals J. Budget Justification (1 page)

A. SCIENTIFIC ABSTRACT

UCSD CRCHD

Application for Pilot/Feasibility Project Grant

(Continuation Page)

UCSD CRCHD

Application for Pilot/Feasibility Project Grant

(Continuation Page)

B. Specific Aims & Significance

C. Research Design and Methods

C1. Impact statement

Describe the direct and indirect impact of your project for reducing or eliminating health disparities, both immediately as well as long-term.

D. Human Subjects

E. Vertebrae Animals

F. Literature Cited

UCSD CRCHD

Application for Pilot/Feasibility Project Grant

G. BIOGRAPHICAL SKETCH

UCSD CRCHD

Application for Pilot/Feasibility Project Grant

H. OTHER SUPPORT

For each key person, list active and pending grants starting: a) title of project; b) funding source; c) performance dates;

d) role on project and percent effort; and e) the major goals of the project.

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UCSD CRCHD

Application for Pilot/Feasibility Project Grant

J. BUDGET JUSTIFICATION

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